But they want to die?

[Antikigirl, ASN, RN]

So yesterday I had a pt on a vent. The pt was 50ish and was end stage COPD. They had a g-tube, j-tube, three wound vacs, foley, and an internal defib.

Okay, I am a med surge nurse and floated only to do general help not take on pts...and till the message came through that I was to be help, I had this pt and two others...okay I was tweeking!

Anyway...this person was in four point restraints...their story, had to be ventilated and what not because of condition. The pt was deemed to be unable to make medical choices...and their family just left her in the hospital. Even their spouse! NO visitors come.

The reason for the restraints, the pt keeps trying to kill themselves. They pull on the vent tubes, block their trache numberous times, and even smashed a phone so they could take the broken plastic and slit their arms (the right way!). This pt has been consistant for over 7 months about their wish to die, and that they never wanted to be in this situation.

Okay harsh ethical probelm here...but for some reason I feel that if the pt is able to purposely break a phone to harm self..that is a good indicator that there is purpose to this action and that should be considered in further tx.

This pt will NEVER be off the vent...never!

I know my own feelings about recovery vs life long mechanical help, and I know my ideas differ from my pts and I am cool with that. But when someone tries daily for 7 months solid daily to end their own life....ummmmm...shouldn't that hold some weight on their own personal wishes?

PTs basically nonverbal..and this is the sticking point. MD's put that in thei charts, instead of anything of use to this pt In other words CYA) and I suggested Geri psych (even though I don't consider her Geri at this point, but it is easier to get help in this situation).

I feel that it is beyond a call from this pt to let them die and not do all this sustained life support. I can see it for a few months...but with no one even visiting or being in her care plan outside the hospital??? Uhgggggggg!

What are peoples thoughts on this...I went home and updated my wishes upon injury/critical state/death right away! And I encourage all my pts to do the same (I have a very nice way of doing it and so far I have about an 80% sucess rate on advanced directives and POLSTS!!!!!).

So basically...what are the thoughts on this...I like hearing others thoughts on these matters to help me be educated and as fair in my own mind as possible (not that it matters about my care of the pt..I do what is necessary and with kindness! But there is a part of me that needs to understand different views for myself only!).

[Tweety, BSN, RN]

They need to somehow assess the patients orientation and if they are alert and oriented. Can the person write? Answer questions with a yes and no answer?

It just seems a crying to shame to tie the patient up and just let her sit there without any help.

I agree that pysche help is definately in order.

And if the patient wishes to be extubated, then the patient should be extubated, etc. and allowed to participate in their own treatment.

[OC_An Khe]

I would refer these patients to the hospitals ethics committee.

[Antikigirl, ASN, RN]

Can not write really...tries, but it isn't readable. Simple yes no they can do, pictures they can do....but I just had this pt for a day and quite the suprise to me, so if I have to work with them again...I may ask social services or MD to use pictures...but then again they have deemed them unable to make choices..............uhhhhhhhhhhggggggggg

Ethics areana....ours tends to go to family to save from hassle . Quite a legal battle and costs $$$ go figure...uhggggggg! (cheeper than the treatment, care, equipment and what not I suppose! But grrrrrrr!).

I will keep trying to get the nurses on that floor to advocate, I was just temp one day there...so I am just going on the nurses and their feelings (which say they know she wishes to have her right to a dignified death). They must do something, I will start the catalyst, but they must follow through!

[Katnip, RN]

Sounds like if the doc or family isn't going to advocate for the patient, then the ethics committee should be consulted. Maybe they can have all the proper assessments initiated and possibly a hospice consult.

[subee, MSN, CRNA]

Sounds like if the doc or family isn't going to advocate for the patient, then the ethics committee should be consulted. Maybe they can have all the proper assessments initiated and possibly a hospice consult.

Theses are the cases that really wear you down. She really needs to have a psychiatrist consult with her. Good ethics are based on the facts, and you don't have her side of the story here. That needs to be done before ethics committee (weak, spineless that they are). I with that getting a driver's license was linked with your living will so that everyone would have one - its just a part of life's business that a responsible person gets done. For myself, I believe that everyone should have a month's supply of Ambien available at all times. I don't want my husband to have to watch me die. For me, death is one of those intensely personal experiences that I just want to do alone. But I don't think nurses deal with death any better than the layman and death is a part of our job - we should be comfortable talking with family members about anticipating death and making it as natural and comfortable as possible. Shame on us for avoiding this part of our job.

[Dinith88]

This pt has been consistant for over 7 months about their wish to die, and that they never wanted to be in this situation.

!).

This statement says it all. Seems your hospital,doctors, whatever have dropped the ball on this one. Poor bugger.

[firstyearstudent]

I really hate how paternalistic the medical profession can be. The right to die should be a basic human right -- even for those who have psychiatric problems. What a nightmare situation. Hopefully, if I ever get a chronic, degenerative illness, I'll have the support, nerve and knowledge to check myself out before I'm too debilitated. I know there can be dignity and spirituality in seeing something like this to the bitter end, but I'm not interested myself. I'm basically a coward and if I'm waiting in misery, I think I'd rather just get it over with. And I think there are plenty of other people who feel the same way. So why isn't assited suicide legal?

I am always so disturbed in clinical when familly members insist on interventions when it is so obvious (to me at least) that the patient does not want them.

"(I have a very nice way of doing it and so far I have about an 80% sucess rate on advanced directives and POLSTS!!!!!)" I always enjoy your posts and your take on things. What's your way of bring up advance directives?

[gonzo1, ASN, RN]

I have put my wishes in writing and encourage everyone I know to do the same. As for this tragic pt, encourage an ethics meeting if possible. Sometimes I must remind myself that we are all in God's hands and leave it to him. Hope that doesn't sound like a cop out. It's all I have.